Novel Access Technology Updates the Femoral Approach

By Zoltan Turi

The technique of femoral artery access has remained largely static since the initial description by Seldinger in 1953.  Although Seldinger’s technique was soon almost universally adopted, its disadvantages have sometimes meant long periods of bed rest, prolonged pressure with associated patient discomfort and a requirement for extended hospital stay. Various advancements, most notably the introduction of vascular closure devices,  have addressed some of these concerns — improving both time to hemostasis and time to ambulation, leading to reduced time to hospital discharge.

The Arstasis device is a further advancement. This novel technology uses a shallow angle arteriotomy to create larger tissue-to-tissue contact for a potentially stronger bond after sheath removal. Blood pressure from within the arterial lumen, combined with relatively brief manual compression, facilitates rapid hemostasis without any foreign body left behind after the sheath is pulled. The Arstasis device has been cleared by the FDA for use in diagnostic femoral artery catheterization.

Our study was designed to address the potential benefits of Arstasis access in a population undergoing diagnostic cath (28% of whom underwent PCI as part of the procedure) and to report any associated complications. We found numerous potential benefits including minimal complication rates (no major adverse events), short time to hemostasis (4.8 + 3.7 minutes including both diagnostic and interventional cases), early sit up after sheath pull, short time to ambulation (2.0 + 2.1 hrs overall; 1.5 + 1.2 hrs for diagnostic caths) and accelerated eligibility for early hospital discharge (6.0 + 7.6 hrs overall; 2.7 + 1.6 hrs for diagnostic patients).

Links:
Use of a Novel Access Technology for Femoral Artery Catheterization: Results of the RECITAL Trial
Zoltan G. Turi, Dale C. Wortham, Gregory C. Sampognaro, Frank D. Kresock, John S. Held, Ray D. Smith, Kalyan K. Veerina, Tomoaki Hinohara, Amir Kaki
Journal of Invasive Cardiology, 2013, January, Vol. 25, no. 1, pages 13-18

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